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Category: Behavior/Psychology Page 24 of 28

Physicians and Patients Make Best Decisions Together

By Nonie Arora

Imagine yourself in this patient’s situation. You have just found out you have cancer, and the next phrase out of your doctor’s mouth is “You’re going to die with this cancer rather than of this cancer.” Which word do you think will jump out of that sentence? “With”? “Of”?

My money is on “die.” – Modified from Critical Decisions, pg. 99

Critical Decisions, Courtesy of www.peterubel.com

In Critical Decisions, Peter Ubel describes a common situation of a urologist explaining a prostate cancer diagnosis to a patient. In this exam room, the physician and the patient are on two different wavelengths. The doctor is trying to assuage the fears of the patient but is emphasizing technical details about the patient’s condition without first relating to the patient’s emotional shock from hearing a cancer diagnosis. Ubel suggests even a small acknowledgement of the patient’s emotional state could improve the situation. For instance, saying “I know it feels awful to be told you have cancer, but you should know that your cancer is curable. We can treat this.” (Critical Decisions, pg. 100)

Ubel, a Professor of Business Administration and Medicine as well as Public Policy, recently published Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. In the book, he explores how the rise in patient empowerment has left many patients confused and physicians unprepared to appropriately partner with patients in making medical decisions.

“My background in clinical medicine, ethics, and behavioral sciences collided. That led me to an in-depth investigation of patient preferences in medical care,” says Ubel. While his ethics background left him sure that patients have the right to ultimately decide their own medical care, he wanted to use his understanding of behavioral economics to uncover how physicians can best help patients make the decisions.

Peter Ubel, Professor of Business Administration and Medicine and of Public Policy. Courtesy of Duke Today.

Ubel also comments on how some emotional desensitization is essential to practicing medicine, and how desensitization can involve medical humor. He says that sometimes physicians “need to step back and laugh at situations, but the danger is we don’t want to laugh at patients.”  He suggested a way to combat the negative aspects of desensitization is to discuss ethical issues during the 3rd year of medical education, when future physicians are being exposed to the realities of medicine through hospital rounds.

He says the bigger worry is that aspiring doctors start off with the right attitude, but beliefs and practices erode through training and practice as physicians. In the current medical system, physicians have many patients and very little time, so doctors can get into bad habits. However, he says that good communication doesn’t take more time – it just takes retaining the right skills. Ubel advocates for physicians to ask patients to explain back what they have understood to get a better idea of patient understanding.

One of Ubel’s next big challenges is studying how cost factors into patient empowerment. Discussions about cost can seem taboo or uncomfortable in the exam room, but costs certainly factor into many health care decisions.

The strength of Critical Decisions is Ubel’s multidimensional perspective: he presents facts from research studies in several disciplines and compellingly (even humorously) draws upon his experiences as a physician, patient, and family member of a patient.

Here’s a link to an excerpt from the book for more!

New Technologies Threaten Cognitive Liberty

By Nonie Arora

Nita Farahany, Duke Law School Professor

Where do we draw the lines when it comes to new technologies in neuroscience?

Duke Law professor Nita Farahany is setting out to answer this question through an exploration of something she calls cognitive liberty. She spoke to a crowd of physicians, nurses, faculty members, and students at the last Trent Center Humanities in Medicine Lecture Series event.

“What does it mean if our conscious awareness of making a decision happens after the decision has already been made by our brains? Does that tell us anything about the concepts of responsibility or freedom of thought?” Farahany asked.

She doesn’t buy into the idea that we are absolved of responsibility because we are essentially predetermined machines, even if scientists like Benjamin Libet have shown that there is brain activity before conscious awareness. She argues that although some things are predetermined, we still have the flexibility of choice. For instance, having many fast-twitch muscle fibers may be a precondition of becoming a world-class track athlete, but the choice remains of whether to train extremely hard to reach the goal.

“We are more than preprogrammed bits and bytes,” Farahany said. Under the assumption that we retain flexibility of our thoughts, Farahany is exploring how those thoughts ought to be protected.

Although neuroscience is still in its infancy, it holds the potential to detect and tamper with memories, she said. But she hopes to explore what types of rights we ought to retain and what limitations there ought to be on the technology.

Farahany said that the mind might hold a lot of information that is very valuable to the government and to businesses. She pointed out that our brains can uniquely identify speakers and sounds. New technologies could detect this information, which could be very valuable to a criminal investigation. But it is it permissible to detect our recognition of objects or people?

Eyewitness testimony has a high rate of falsity and sometimes witnesses lack memories of key information. However, what if false memories could be planted in eyewitnesses easily? Most people would agree that it would be impermissible for the government to create its own “star witness,” Farahany maintained.

Propranolol, a beta-blocker that may stop consolidation of fear. Courtesy of Mind Disorders

While many may worry about enhancement of selves or memories, diminishing memories is another concern. The drug propranolol, a beta-blocker, has significant promise for people who have suffered from a traumatic experience because it can block consolidation of fear, said Farahany. For instance, rape victims who take propranolol may be less likely to develop post-traumatic stress disorder. “When given the opportunity to intentionally diminish experience of an emotion, should [people] be able to do so?” she asked. Compensation through the tort system is based upon the degree of suffering. Would the compensation for a victim of a rape be decreased by using the drug? Alternatively, do victims have a responsibility to reduce their own suffering by taking the drug?

There are many more questions to answer, and Farahany hopes to do so with her framework of cognitive liberty that considers the pillars of self-determination, consent, freedom of thought, and risks and benefits to individuals and society when deciding where to draw the lines.

 

Gecko's stick inspires adhesives and even superheroes

By Ashley Yeager

A single hair on a gecko’s foot has enough “stickiness” to pick up an ant. Credit: Kellar Autumn, Lewis & Clark College.

Sticky feet driving you up the wall?

Well, maybe not. But they are for Cicak, or Gecko-Man. After a few sips of coffee contaminated by a virus-infected gecko, a loser lab scientist suddenly becomes a Malaysian superhero, sticking to walls, using his tongue to scale skyscrapers and even eating bugs.

“Gecko feet are nature’s best adhesion and removal device,” said Lewis & Clark College biologist Kellar Autumn. He gave the keynote speech during the awards ceremony of the third annual Abhijit Mahato photo contest on Nov. 7.

While Autumn riled up the audience with his images and videos of the science behind gecko feet and their inspiration for new adhesives, robots and superheroes, he also used the talk to remind the photographers in the audience that appearance and scientific images can be misleading.

The science of how geckos climb up walls and across ceilings is at least a 200-year-old question, one that even Aristotle tried to answer. In the late 1960s, one scientist took some scanning electron microscope images of gecko feet and thought they revealed suction cups as the mechanism that let geckos scale walls and ceilings. But that idea was wrong.

It wasn’t until Autumn and his collaborators began looking more closely at the creature’s feet in the late nineties and early 2000s that scientists realized it wasn’t suction, but nanometer-scale interactions between a surface and the gecko’s foot hairs, or setae, that let them stick, release and climb. His team took a single gecko foot hair and made the first direct measurement of its adhesive function. Turns out the stickiness in one hair is so strong it can lift the weight of an ant.

The team also discovered that geckos release their feet as they climb by changing the angle of their feet hairs. That means that the contact geometry of setae are more important that any other factor in their ability to climb, Autumn said, adding that the discovery demonstrated “we could make this stuff.”

Tom Cruise climbs a skyscraper with “gecko gloves: in MI:Ghost Protocol. Image courtesy of: Danny Baram.

He showed videos of both the kinematics and kinetics of the way geckos climb and compared and contrasted the physics the creatures use to the human-engineered “nanopimples” and wedge-shaped nanoridges that resemble geckos’ sticky feet. The animal’s foot physics is “different than pretty much everything else out there,” Autumn said, though he did describe several developing projects to try to mimic the animals’ movements.

Still, he said, he’s convinced that “had geckos not evolved their sticky feet, humans would not have invented adhesive nanostructures.” And, there’s no way we’d have gecko gloves or could even think of gecko band-aides and the other cool applications of gecko-feet science, he said.

Citations:

“Adhesive force of a single gecko foot-hair.” Autumn, K., et. al. (2000). Nature 405, 681-685.

“Evidence for van der Waals adhesion in gecko setae.” Autumn, K., et. al. (2002). Proc. Natl. Acad. Sci. USA 99, 12252-12256.

“Evidence for self-cleaning in gecko setae.” Hansen, W. and Autumn, K. (2005). Proc. Nat. Acad. Sci. U. S. A. 102, 385-389.

Film Presents Alan Turing In Full; Duke Preview Monday

Guest post by Pender M. McCarter, Trinity College (1968), Senior Public Relations Counselor, IEEE-USA/Washington

Codebreaker publicity image

A scene from the movie “Codebreaker” about the life of Alan Turing.

Alan Turing has been hailed as a digital Darwin, an Einstein and a Newton who helped to “catapult civilization in to the digital age.” The British mathematician laid the groundwork for everything we do with computers today, according to Apple co-founder Steve Wozniak. The Turing Machine incorporated all the basic aspects of computer input and output. His 1950 paper, “Computing Machinery and Intelligence,” posited that computers can be programmed to mimic human behavior. And at the end of his life, Turing wrote about pattern formation in biology, what he called morphogenesis, that could be observed in animal stripes and spirals and even exist in ecosystems and galaxies.  Turing is best known for leading the British Bletchley Park code breakers team that cracked Germany’s Naval Enigma Code, helped end World War II, and saved perhaps millions of lives.

Yet until recently Turing’s contributions have been little known or appreciated outside of the sci-tech community. And his personal life as a gay man has generally been glossed over. In 2012, the centenary of Alan Turing’s birth, hundreds of events have been held worldwide. A new film, Codebreaker, presents Turing’s personal and professional life without flinching, including how his sexual nature contributed to his extraordinary achievements and tragic downfall.

The drama documentary emphasizes that the support and encouragement Turing enjoyed with other eccentric and brilliant technologists at Bletchley Park motivated and sustained him. When he lost this community after World War II, at a time when there was a craving for normalcy and scant tolerance for non-conformists, Turing learned how unforgiving the world could be.

The drama scenes in Codebreaker center on the psychotherapy sessions Turing participated in during the last 18 months of his life.  In these final months, Turing faced persecution as a gay man under the same 19th century British laws that were used to prosecute Oscar Wilde.  In 1954, at the age of 41, Turing committed suicide leaving us to wonder about potential future accomplishments  in a more accepting and tolerant time. In 2009, former British Prime Minister Gordon Brown apologized posthumously to Turing: “We’re sorry; you deserved so much better.”

Codebreaker will be screened at the Duke Center for LGBT Life (02 West Union Building) on Monday, Oct. 29, from 7-8:30 p.m., with underwriting from IEEE-USA, the Washington-based office of the IEEE, the world’s largest professional association for the advancement of technology. The drama documentary will be introduced by Executive Producer Patrick Sammon, who will also answer questions about the film.

Here’s a link to the trailer: http://www.turingfilm.com/

A "Neurodiverse" View of Poetry

By Ashley Mooney

Why is an English professor working with brain scientists? To change our understanding of the interaction between autism and poetry.

Autism spectrum disorder is often characterized by an inability to comprehend figurative language, especially metaphors. But poet Ralph Savarese, an associate professor of English at Grinnell College currently doing a residency with the Duke Institute for Brain Sciences as a Mellon Humanities Writ Large Fellow, has found the exact opposite to be true in his interactions with people who have autism.

“One of the supposed symptoms of autism is an inability to deal with figurative language—metaphor, simile, irony, jokes—and what I can tell you is, it is not true about certain autistic subtypes, particularly literate classical autistics,” he said.

Literate classical autistics are the most severely autistic, and often nonspeaking. Savarese, who also teaches creative writing workshops to people with autism, noted that although it often takes years to teach these people how to read, once learned “there is absolutely no failure of figurative knowledge, indeed just the opposite is enormous sensitivity to metaphor [and] simile.”

Poetry is not abstract, but rather is about the concrete particulars of life, Savarese said, which lines up nicely with an autistic neurology. He noted that poetry or lyrical language could serve as a neurocosmopolitan meeting place. Neurocosmopolitanism means to be comfortable with various neurologies.

“What would [neurocosmopolitanism] mean as a doctor or as an English professor who might have somebody with autism in his classroom?” he asked. “It’s not just that I’m demanding that autistics learn how we do things, it’s that we learn how they do things.”

What would it mean to be comfortable with all matter of neurologies, what would it mean to find common ground or talk or find a way to communicate respectfully with somebody whose brain is different, he added.

Rather than seeing disability as “an occasion for pity or demonization,” Savarese instead reframes autism as a type of neurodiversity—a neurological difference.

“For the last 30 years we’ve had this notion of diversity drilled into us, why not neurodiversity,” he said. “It’s true that autistics can do some things better than us and some things worse than us.”

Unlike 30 years ago, there are now many people who have autism across the spectrum who have written about their experiences, he said. With a large volume of literature at hand, people can now familiarize themselves with both the traditional medical view from an outsider’s perspective and insider accounts. He added that people should familiarize themselves with both because they generate different notions of the world.

Savarese has a personal connection to autism. His adopted son DJ is nonspeaking autistic who types to communicate. DJ, who started school at Oberlin College three weeks ago, is also the first nonspeaking autistic person to ever get into a highly selective college, he said.

“It’s not that I’m unrealistic—I’ve lived with the challenges of autism for 14 years,” Savarese says. “I’m not saying there aren’t significant challenges with autism, but I refuse to describe autism in the way that it has been typically described.”

He noted that although his son has significant motor and communication challenges, his memory and pattern recognition are astonishing. “His memory is photographic, and he’s just like, ‘are you kidding me, you all are retarded.’”

Savarese noted that the struggle in how to treat people with autism was exemplified in an interview that his son did. In the interview, he was asked if autism should be treated, and DJ typed in response, “yes, treated with respect.”

Although the most famous disability rights adage is “nothing about us without us,” he said, adding that there is a division between the literature written by autistics and scientific research that rarely makes an appeal to those with autism.

“What you see is somebody a lot like you or me going to some other culture that is very different from our own and insisting that culture operate the way that ours does,” he said. “Almost everything that I stand for is in opposition to many of the ideas [of what autism is] and the ways in which the ideas have been propagated. There is this idea autistics have no awareness of the self or others…. I just don’t buy it.”

Igniting U.S. health care's 'escape fire'

The film Escape Fire explores what's fanning the flames of the health care debate. Credit: escapefiremove.com

By Ashley Yeager

Imagine lighting a match to protect yourself from the flames of a fire.

It’s probably not the first thing you would think to do to stop from being burnt. But when there’s no other escape, the technique works. In 1949, Robert Wagner Dodge became living proof when he lived through the Mann Gulch fire by setting his surroundings on fire.

Now, his actions have become a metaphor for drastic ways government and industry should change U.S. health care before it too burns everything in its path.

Escape Fire: The Fight to Rescue American Healthcare showcases the health care system’s metaphorical blaze. The award-winning documentary, described as the “Inconvenient Truth” of the health care debate, opens nationwide in October. But members of the Duke community saw it for free on Wed., Sept. 19. They were also able to participate in a post-film panel discussion, which fleshed out a few potential escape fires for the health care industry.

“I think working with one patient at a time can help everyone become healthier,” said Annie Nedrow, a primary care physician and the associate director of Duke Integrative Medicine, which sponsored the event. But as the film points out, the current system rewards doctors for the number of patients they see, not the amount of time they spend with each person or the plans they may develop to help that patient prevent and manage disease.

Ironically, almost 75 percent of health care costs are spent on preventable diseases. The film, directed by Matthew Heineman and Susan Froemke, illustrates this statistic through anecdotes, where a band-aide, pill or even invasive surgery, such as inserting a stent to relieve heart blockages, provides immediate relief but does nothing to address the underlying causes of illnesses – typically diet and lifestyle.

Preventable diseases are 75% of our health care costs. Credit: escapefiremovie.com

“There’s got to be a shift in our culture, one where we actually have access to safe parks to exercise, healthy food, and the time to eat it,” said Adam Perlman, Duke Integrative Medicine’s executive director. He also agreed with Nedrow that a new system should invest more in primary care and health promotion, rather than disease treatment.

To set an example and test the feasibility of such a system, Duke Integrative Medicine has opened a primary care practice that limits the number of patients each physician sees so the doctors can spend more time with each patient and create a more holistic approach to that person’s health.

Perlman said that health coaching could be another important aspect of correcting the healthcare system. He explained that doctor X might tell a patient to lower his blood sugar, doctor Y then tells him to lower his blood pressure, and all the patient really wants to do is dance at his daughter’s wedding. “A health coach helps the patient reach those bigger goals by connecting the dots and helps them execute the plan to get there,” he said.

The film and remarks prompted many audience members to question what it would take to change the current system. Nedrow, who said she has been inspired by books on creativity and innovation, suggested that it was dialogues like the one they were having that could ignite change to repair the broken model of health care or create a new system.

More innovation, however, may mean that more people need to step into the fire and strike a match, rather than run and try to dodge the flames.

Monkey Marketing and Poop-Dodging

by Ashley Mooney

Have you ever thought of advertising to a monkey?

Junior Yavuz Acikalin, an economics and neuroscience double major, is doing an independent research project with the Platt Lab that deals with just that—monkey advertising. Acikalin’s project deals with whether or not one can influence primate reward preferences by branding rewards. Branding involves using associations between brand logos and images of female monkey perinea—“sexy images” for monkeys in his words—and high status male faces.

“Finding similarities between how mainstream methods of marketing affect humans and monkeys can lead to a better understanding of the evolutionary factors that affect consumer behavior,” he said. “Experiments on monkeys can help us better understand the irrationalities that happen in the markets, and more importantly, the brain mechanisms that underlie the effects of advertising on consumer behavior.”

The lab, run by Michael Platt, director of the Duke Institute for Brain Sciences and Center for Cognitive Neuroscience, studies how the brain decides between different actions. A main focus of the lab is on value-based decision making, and the brain mechanisms responsible for these processes—in summary, neuroeconomics, Acikalin said.

His daily duties include writing Matlab code for the touch-screen interface that the monkeys use, he said. He also writes code for data analysis and runs the experiments.

Acikalin noted that he loves animals and cannot live without having multiple pets at home, making his time with the monkeys rewarding. His research, however, does come with its downsides.

“My least favorite part is dealing with all the biohazard on a daily basis—or more precisely, monkey poop,” he said.

A Different Kind of "Knock Out Mouse"

by Ashley Mooney

What is the best method to test anxiety in mice? I spent my summer at home in Portland, Ore. figuring out just that.

According to the National Institute of Mental Health, one in five adults in the United States have an anxiety disorder, but only about a third of those people are receiving treatment. In order to develop better medications, we wanted to understand the mechanism by which injuries—such as traumatic brain injury—lead to anxiety disorders.

The "guillotine" I helped build to model traumatic brain injury in mice

The lab was using six tests on mice, including the elevated plus maze, acoustic startle response and  the “hyponeophagia test”—which examined how long it took a mouse to consume a new food.  My boss, a postdoctoral researcher, ran a series of correlations on test results to find that some are not as effective in testing anxiety as scientific journals say they are.

I helped build two of the other tests that were new to the lab. One of them was a guillotine of sorts to test traumatic brain injury. While the guillotine does not do anything gruesome to the mice, it does give them a minor concussion to model the type of injury that many people experience in sports, car accidents and other mishaps.

We were looking at whether traumatic brain injury increases your chance of developing anxiety. To do this, we conditioned 80 mice and put them through mazes before and after knocking them on the head.

Although the mice kept me pretty busy, the head veterinarian of the research institute allowed me to shadow him in the mornings and help out with the pigs and rodents.

And a lesson from all of my maze-building experiences: chloroform is useful for more than knocking people unconscious—one can use it to bind plastic together and create a plethora of fun experiments for mice to run around.

Culture shapes bird communication, too

SingingSwampSparrow_RL

A male swamp sparrow switches branches as he sings.Credit: Robert Lachlan, Duke.

Guest post by: Eugene Morton, York University

Bird song is one of the most fascinating and complex examples of animal communication, and the quest to understand its evolution and function has fueled the careers of many behavioral ecologists, psychologists and neurophysiologists.

Recently, scientists in the Departments of Biology and Neurobiology at Duke University have made incredible advances in this field. In “Songbirds learn songs least degraded by environmental transmission,” Susan Peters, Elizabeth P. Derryberry, and Stephen Nowicki show how a youngster chooses which songs to learn from the huge number they may be exposed to during their learning period.

Their simple but elegant experiment offered the birds a choice to learn songs that contained echoes versus no echoes and the birds chose to learn only those with no echoes. The rejected songs had been transmitted and re-recorded through 25 meters of habitat, and picked up reverberations and a few other changes along the way, but they were equally loud to the learned versions.

This says a great deal about how birds put to use their extraordinary ability to hear small time differences. What’s so great about hearing echoes?

Compared to our ability, where we hear only echoes from distant large objects, birds can hear echoes from tree trunks and vegetation. They use this ability to learn songs that transmit with the least amount of echoes or, more generally, degradation.

In this way, the birds themselves reject songs less well suited to their environment; cultural selection. As the birds were housed together while learning the songs it is not surprising that they came up with two that were never presented to them; they must also have learned from each other.

SingingSwampSparrow

A male swamp sparrows sings to his neighbors.Credit: Robert Lachlan, Duke.

Why is it important to understand the criteria birds use to choose songs to learn? I would answer because then we can understand how cultural and natural selection interact. Cultural selection favors birds that learn songs that will propagate for the greatest distance and remain undegraded.

These songs must function better than a random selection of songs would. The function must related to how the listeners of these songs are affected by them: are they more efficiently repelled if they are competitors and attracted if they are potential mates? Natural selection will favor the birds whose songs do this the best.

And it turns out that this interplay is helping birds cope with increasingly human-influenced environments. The traffic noise we generate can favor learning songs that are higher or lower in than the frequency of this noise. This ability is based upon the same cultural choice of songs described here for swamp sparrows.

It is hoped that this excellent study will stimulate others to assess the role of learning in adapting songs, not only to habitats, but to the social functions songs have. Songs function over distance and this study describes how song learning can strengthen this role and the importance of distance in song evolution.

Eugene S. Morton
Hemlock Hill Field Station, Pennsylvania
York University, Ontario, Canada
mortone@si.edu

Betting on Bayesball

By Ashley Yeager

Derek Jeter, upper left, and Alex Rodriguez, lower right, anticipate a grounder in a 2007 game . Credit: Wikimedia.

New York Yankees shortstop Derek Jeter has five golden gloves. Alex Rodriquez, a Yankees shortstop and third baseman, has three.

It wasn’t a surprise then when Sayan Mukherjee asked a crowd at Broad Street Café who was a better mid-fielder and Jeter got a few more cheers.

The question, and response, prompted Mukherjee, a statistician who studies machine learning, to launch into a discussion about intuition and statistics in sports, specifically in baseball. Mukherjee spoke on June 12 as part of Periodic Tables: Durham’s Science Café.

He admitted he was a Yankees fan, which elicited some booing. Laughing it off, he then showed a complex statistical equation his colleague, Shane Jensen at the University of Pennsylvania, and others use to calculate a player’s success at fielding ground and fly balls.

On the next slide, Mukherjee showed the results. Rodriquez was clearly on top, and Jeter closer to the bottom. “Jeter doesn’t have as big a range as other players, that’s all I’m suggesting,” Mukherjee said.

Of course, these statistics, called sabermetrics, aren’t new to Jeter and other players. The numbers, based on Bayesian statistics, are exactly what the Oakland A’s baseball team used in 2002 to build a winning team. And, when new numbers came out in 2008, the stats ranked Jeter fairly low as a defensive player. He responded by saying there was a “bug” in the model.

“He has a point. The exact conditions for each play are not the same, so it’s hard to truly compare them,” Mukherjee said. The equation, however, is a way to measure factors of the game, rather than rely on intuition, and statisticians are trying to add more factors to make the model more realistic. The next factor they want to add will account for the different designs of ballparks, Mukherjee said.

He added, though, that these stats don’t really put players’ jobs at jeopardy. Judging by the crowd’s first response, people obviously still rely on intuition when it comes to picking their favorite players. The cold, hard numbers therefore affect how players approach their game – ie Jeter’s post-2007 season focus on a training program to combat the effects of age, Mukherjee said.

The data also affect people betting on the games. “Betting is huge, in any sport,” Mukherjee said, and the numbers, it seems, can affect how people choose to risk their money, but not their team loyalty.

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